Form 54.29 - Affidavit As To Location Of Real Estate And Personal Property In North Dakota - 2006

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Form 54.29
State Of North Dakota
Offi ce Of State Tax Commissioner
Affi davit As To Location Of Real Estate And
Personal Property In North Dakota
1. ESTATE OF___________________________________________________________________________, DECEASED.
2. STATE OF NORTH DAKOTA )
)
County of _________________ )
3. I, ___________________________________________________ being fi rst duly sworn, on oath depose and say:
a.
That I am the personal representative for the estate of the decedent named above;
b. That the decedent was a resident of _______________________________ _______________________________
(City)
(County)
_______________________________ at the time of death; and
(State)
c.
That the total gross value of estate properties with situs in North Dakota owned by the decedent at the time of death
were located in the following cities and rural areas:
In _____________________________,
_____________________________
$ ________________________
City
County
In _____________________________,
_____________________________
$ ________________________
City
County
In _____________________________,
_____________________________
$ ________________________
City
County
In _____________________________,
_____________________________
$ ________________________
City
County
In Rural ________________________________________________
County
$ ________________________
In Rural ________________________________________________
County
$ ________________________
In Rural ________________________________________________
County
$ ________________________
In Rural ________________________________________________
County
$ ________________________
Total Gross Estate
$ ________________________
4. North Dakota Estate Tax ................... $ __________________
5. Interest .............................................. $ __________________
6. Total Tax Plus Interest ...................... $ __________________
I, the personal representative of this estate, do hereby swear, under the penalty of perjury, that the information provided in this
affi davit is true and correct to the best of my knowledge.
Dated this ______ day of _______________________, 20____.
_________________________________________________
Signature of Personal Representative
Subscribed and sworn to before me this ______ day of ______________________, 20____.
_________________________________________________
Notary Public for Personal Representative
Approved by State Tax Commissioner this _____ day of _____________________, 20 ____, at Bismarck, North Dakota.
Tax File No. _____________________________
Ryan Rauschenberger
Tax Commissioner
_________________________________________________
Estate Tax Examiner
(Submit In Duplicate)
24133 (updated 1-2006)

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